Blackmores Institute

Both vitamin D and calcium supplements are recommended for the prevention of fracture however, earlier randomised controlled trials have reported conflicting result, with uncertainty about optimal doses and regimens for supplementation and tie overall effectiveness.
 
 The researchers undertook several meta-analyses as part of the study.
 
 A meta-analysis of six randomised controlled trials (48,982 participants, 5449 fractures and 730 hip fractures) found that combined supplementation with vitamin D (daily doses of 400-800 IU), and calcium (daily doses of 1000- 1200 mg) resulted in a 6% reduced risk of any fracture and a 16% reduced risk of hip fracture.
 
 “In our meta-analysis of 11 observational studies with over 39,000 participants and more than 600 fractures and 2000 hip fractures each increase of 10.0ng/mL in 25(OH)D concentration was associated with an adjusted relative risk any fracture of 0.93 (95% CI, 0.89-0.96) and adjusted relative risk of 0.80 for hip fracture (95% CI, 0.75-0.86),” the authors reported.
 
 In contrast, the meta-analysis of 11 randomised controlled trials (34,243 participants, 2842 fractures, 740 hip fractures) of vitamin D supplementation alone ((daily or intermittent dose of 400-30 000 IU) did not find a reduced risk of any fracture or hip fracture, however, these trials were constrained by infrequent intermittent dosing, low daily doses of vitamin D, or an inadequate number of participants.
 
 “The combined supplementation with vitamin D (daily doses of 400-800 IU, yielding a median difference in 25[OH]D concentration of 9.2 ng/mL) and calcium (daily doses of 1000- 1200 mg) found a 6% reduced risk of any fracture (RR, 0.94; 95% CI, 0.89-0.99) and a 16% reduced risk of hip fracture (RR, 0.84; 95% CI, 0.72-0.97),” the authors said.
 
 ‘While the risk reductions achieved in the randomised controlled trials of calcium plus vitamin D were somewhat greater in trials among older people living in institutions and in trials that achieved greater differences in blood 25(OH)D concentrations between allocated treatment groups; the uncertainty in the 95% confidence interval for some of the estimates, warrants further large randomised controlled trials of combined treatment with vitamin D and calcium before advocating vitamin D and calcium supplements or fortified foods with vitamin D and calcium for prevention of hip fracture.”
 
 “In this systematic review and meta-analysis, neither intermittent nor daily dosing with standard doses of vitamin D alone was associated with reduced risk of fracture, but daily supplementation with both vitamin D and calcium was a promising strategy,” the authors concluded.
 
 Source:
 JAMA Network Open. 2019. DOI:<a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2757873">10.1001/jamanetworkopen.2019.17789</a>

Combining vitamin D supplementation with calcium offers promise as a strategy to reduce risk of fracture findings of a meta-analysis has reported in the online publication, JAMA Network Open.

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